I really dislike the label "substance abuse disorder."

I get that it is kinder than calling someone an addict but the line is blurred as to who substance abuse disorder refers to. Substance abuse and addiction are distinctly two separate worlds (in my opinion) and should be defined that way. Anyone who uses drugs occasionally is certainly not an addict but someone whose life is out of control is surely in a different class and should not be treated the same.

Substance abuse disorder (SUD), as defined by insurance companies, pharmaceutical companies, the medical profession and the government covers anyone from a recreational user to a hardcore brain damaged person who has lost control of his or her life. There are many who disagree with this catch all phrase however.The differences between the two are enormous. One has "free-will" and a healthy rational brain for thinking, the other has suffered brain damage and no longer has "free will" or the ability to make choices because his/her brain is under the control of the addiction suffered.  How can we blindly treat both conditions the same?

The danger of combining the terms is in the treatment. Millions of dollars have been and will continue to be poured into the system from lawsuits against promoters of  opioid pain killers. Much of that money is going towards education and harm reduction. I do not hear about amounts going towards sober living or recovery communities. One hears a lot of publicity about evidence based treatment and the success of medication assisted treatment (MAT). Millions of dollars are being spent on making the harm reduction drugs easily available and the general population believes that our problem is being solved. We are given the impression that MAT is the "Magic bullet" to reduce the number of overdoses. The truth is that yes, it reduces overdoses and is a good tool in the fight against SUD and addiction. The harm reduction is a result of being able to control the quality of the medication. Both methadone and buprenorphine (suboxone) are highly addictive medications on their own. The amount of morphine derivative contained in buprenorphine is actually much higher than that of heroin and almost as high as that found in fentanyl. It is the additive naloxone that is combined with it to avoid the danger of overdosing. Their manufacture is controlled so there is a degree of safety. Be mindful of the numbers however, and the misunderstood belief that MAT cures addiction. It does not cure, it "manages" the addiction. Once the drugs are withdrawn, the addiction is still there.

I see another problem with the broad scope of SUDs and addictions. It may happen that the distribution of buprenorphine is prescribed for SUDs on the lower end of the scale. People who might better be treated with individual and group therapy. Both methadone and buprenorphine are highly addictive and may be harder to kick than the substance they are replacing. While these harm reduction drugs may work w well with substance abuse disorders, it will not necessarily have an effect on hard core addicts/alcoholics. Harm reduction is more difficult in hard core addiction because of the lack of free will and brain damage that has assaulted the brain. Hard core addicts will likely have difficulty being compliant with the medication and are also likely to find other means to get high by drinking dangerous levels of alcohol and/or using other illegal drugs such as meth and fentynal.